Research for stronger health systems during and after crisis

Reflections on ReBUILD sharing and learning at the African Health Economics Association Conference, 2014,

Saturday, 01 Mar 2014

Haja Wurie, ReBUILD  Sierra Leone (Research Co-ordinator and Research Uptake Officer)

In March of this year I attended the third conference of The African Health Economics and Policy Association (AfHEA). AfHEA promotes the generation of high quality policy relevant evidence particularly in the fields of health economics and health financing and  works towards an end goal of improving health outcomes in Africa. To that end, health economists and policy analysts gathered to discuss the post-2015 African Health Agenda and Universal Health Coverage (UHC): Opportunities and Challenges.

The conference created the ideal information sharing and networking platform for a young researcher like me, as it brought together like minded researchers working towards a common goal of increasing access to health care for all. I particularly enjoyed the sessions on national health insurance, a scheme currently being developed for piloting in Sierra Leone and which is pertinent to the ReBUILD’s work on health financing  in post conflict situations. These sessions gave me valuable insight into the operational mode of a national health insurance scheme in other African countries.

The key sub-themes of this conference included:

High level policy maker’s panel on UHC and the post 2015 African health agenda

Joint AfHEA-WHO/AFRO session on UHC and health financing in the African region

Joint AfHEA / NICE Session: Economic evaluation: a tool for priority setting in the context UHC - Learning from the international experience

How to measure UHC: presentation of ongoing work by teams from GNHE, USAID and WHO/World Bank.

In addition, sessions were organized to address the following questions:

  • Why is universal coverage important for African countries?
  • What progress has been made towards achieving UHC and what are the remaining challenges in moving towards universal coverage in Africa?
  • What pre-payment mechanisms can be considered to support progress towards universal coverage in the African context?
  • How can additional resources be mobilised to support progress towards universal coverage in the health sector?
  • How can existing resources be used more efficiently and equitably?
  • What roles should be played by different actors?
  • How can tools for monitoring and evaluation towards UHC be developed and strengthened?

ReBUILD research seeks to address some of these issues with a focus on the particular contexts of post conflict environments, including health financing, contracting and incentive mechanisms and human resources for health amongst others This feeds into the overall aim of moving towards universal health coverage. ReBUILD researchers Sophie Witter and myself Haja Wurie (ReBUILD Sierra Leone) participated in the some of these sessions, and we both gave oral presentations about the work of ReBUILD.

The first - Health worker incentive environments during and post-conflict: early findings from ReBUILD presented preliminary findings from the in-depth interviews with health workers  in Sierra Leone about their experience during and post conflict,

The second Contracting of Health Care: Process and Effects in Sierra Leone had a focus on the performance based scheme (PBF) in Sierra Leone 

A third presentation was given by Sophie Witter on findings from health financing research from the ReBUILD partner countries. 

The PBF presentation from Sierra Leone generated interest from other PBF implementing countries (Zambia, Zimbabwe, Chad and Burkina Faso) with Chad and Burkino Faso interested in information sharing as they are also in the early implementation phase.  Participants feedback centred on the sustainability of this approach (as the national owner in Sierra Leone is currently weak) and it's possible distortion effect on health workers priorities (i.e. health workers possibly ignoring other outcomes not measured by the PBF assessment) and the degree of governance around the disbursement of funds and the role of the Ministry of Finance and Economic Development in this process.

Overall, the conference gave me a valuable opportunity to present my research and also gain from other’s experience in taking forward future ReBUILD research.